Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 6, 2020; 8(3): 540-545
Published online Feb 6, 2020. doi: 10.12998/wjcc.v8.i3.540
Successful kidney transplantation from an expanded criteria donor with long-term extracorporeal membrane oxygenation treatment: A case report
Hye Won Seo, Sua Lee, Hwa Young Lee, Sun Cheol Park, Byung Ha Chung, Chul Woo Yang, Tae Hyun Ban
Hye Won Seo, Sua Lee, Byung Ha Chung, Chul Woo Yang, Division of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea
Hye Won Seo, Sua Lee, Byung Ha Chung, Chul Woo Yang, Transplant Research Center, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea
Hwa Young Lee, Division of Nephrology, Department of Internal Medicine, Jeju National University Hospital, Jeju-do 63241, South Korea
Sun Cheol Park, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seoul 06591, South Korea
Tae Hyun Ban, Division of Nephrology, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Eunpyeong-gu, Seoul 03312, South Korea
Author contributions: Seo HW reviewed the literature and contributed to manuscript drafting; Yang CW and Lee HY were the patient’s physicians, reviewed the literature, and contributed to manuscript drafting; Park SC was the patient’s surgeon, reviewed the literature, and contributed to manuscript drafting; Lee S and Chung BH reviewed the literature and contributed to manuscript drafting; Ban TH and Yang CW were responsible for revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Tae Hyun Ban, MD, Clinical Assistant Professor, Division of Nephrology, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 1021 Tongil-ro, Eunpyeong-gu, Seoul 03312, South Korea. deux0123@catholic.ac.kr
Received: November 26, 2019
Peer-review started: November 26, 2019
First decision: December 23, 2019
Revised: December 30, 2019
Accepted: January 8, 2020
Article in press: January 8, 2020
Published online: February 6, 2020
Processing time: 71 Days and 22 Hours
Abstract
BACKGROUND

Due to a shortage of donor kidneys, many centers have utilized graft kidneys from brain-dead donors with expanded criteria. Kidney transplantation (KT) from donors on extracorporeal membrane oxygenation (ECMO) has been identified as a successful way of expanding donor pools. However, there are currently no guidelines or recommendations that guarantee successful KT from donors undergoing ECMO treatment. Therefore, acceptance of appropriate allografts from those donors is solely based on clinician decision.

CASE SUMMARY

We report a case of successful KT from a brain-dead donor supported by ECMO for the longest duration to date. A 69-year-old male received a KT from a 63-year-old brain-dead donor who had been on therapeutic ECMO treatment for the previous three weeks. The recipient experienced slow recovery of graft function after surgery but was discharged home on post-operative day 17 free from hemodialysis. Allograft function gradually improved thereafter and was comparatively acceptable up to the 12 mo follow-up, with serum creatinine level of 1.67 mg/dL.

CONCLUSION

This case suggests that donation even after long-term ECMO treatment could provide successful KT to suitable candidates.

Keywords: Extracorporeal membrane oxygenation; Kidney transplantation; Delayed graft function; Donor selection; Case report

Core tip: Graft kidneys from expanded criteria donors have been utilized following shortage of donor kidneys. Kidney transplantation (KT) from extracorporeal membrane oxygenation (ECMO) donors has been successful. However, limited data on clinical outcomes after KT from ECMO donors left acceptance of these marginal kidneys solely to clinicians. We report a rare case of successful KT from a brain-dead donor who had been supported with therapeutic ECMO for three weeks before the donation. This strongly suggests that expanded criteria donors’ kidneys, even after a donor has been on ECMO for a relatively long duration, can provide favorable outcomes in well-selected recipients.